P655: RACIAL AND SOCIOECONOMIC DISPARITIES AMONG PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA IN THE US: ANALYSIS OF SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS PROGRAM DATA
Authors: A. Kittai, Y. Huang, J. Fisher, S. Bhat, M. Grever, E. Paskett, K. Rogers, J. Woyach
Journal: HemaSphere (2022)

Background: Therapy for chronic lymphocytic leukemia (CLL) has changed dramatically over the past 20 years. With the cost of new therapies and rapid practice changes, it is unclear if patients are benefiting equally from this progress. We assessed Surveillance, Epidemiology, and End Results (SEER) program data to determine how race and socioeconomic status (SES) affect survival for patients with CLL. Aims: Aim 1 - Determine the prognostic significance of race on overall survival for patients with CLL. Aim 2 - Determine the prognostic significance of socioeconomic status on overall survival for patients with CLL. Methods: CLL cases reported to 18 SEER Program registries from 2006 – 2018 were included. Patient characteristics such as age at diagnosis, sex, year of diagnosis, race, and SES as determined by rural/urban census tract residence (RUCA), and neighborhood (as represented by the Yost Index, a composite measure of 7 variables assessing different aspects of the SES of a census tract) were collected and analyzed. Multivariable cox regression (MVA) was used to determine adjusted odds of survival. Two separate databases were utilized, one which included data to 2018, and another which contained SES data but only had data available to 2016. Results: 46,605 cases from 2009 – 2018 were identified without SES data. The median age was 70 years, 60% were male, and there was an even distribution of patients diagnosed with CLL annually from 2009 – 2018. Of the cases with race reported, 89.9% were white, 7.3% Black, 2.4% Asian/Pacific islander, and 0.3% American Indian/Alaska Native. After a median follow up of 47 months, the median 3-, 5-, and 10-year overall survival (OS) was 79.5%, 69.5%, and 48.8%, respectively. MVA showed Black race (HR 1.5, 95% CI 1.4 – 1.6) as the strongest independent prognostic variable for worse OS controlling for year of diagnosis, suggesting race was a significant factor in OS in the era of modern therapies. Using the linked RUCA and Yost tertiles for SES, 47,867 cases of CLL from 2006 – 2016 were analyzed. Like the prior analysis, median age was 70 years, 60% were male, and there was an even distribution of patients diagnosed with CLL annually from 2006 – 2016. Of the cases with race reported, 90.4% were white, 7.1% Black, 2.3% Asian/Pacific islander, and 0.3% American Indian/Alaska Native. Per the Yost index, 24.8%, 33.8%, and 41.4% of patients were in Groups 1, 2, and 3, respectively. Per RUCA categories, 8.9% and 91.1% of patients were residents of rural and urban areas, respectively. MVA showed American Indian/Alaska Native, and Black race as independent prognostic variables for worse OS, and Yost group 2 and 3, representing higher SES, were found to be significant independent prognostic variables for improved OS (Table 1). In this analysis, race remained an independent variable for worse OS after controlling for SES. Image:Summary/Conclusion: Black race and low SES are prognostic of OS in CLL. Further research is needed to determine whether this is due to access to therapy, quality of care, social determinants of heath, or disease biology.